Apparently some people still have no idea what is in the new Health Care Law. They didn't nationalize anything. One of it's biggest provisions is that people are finally REQUIRED to buy health insurance. Everyone uses health care sooner or later, I have no problem with requiring that people be able to pay for it. It also is FAR cheaper to treat people early at a clinic than treat them at a hospital (both in medical bills and overall economic impact).

And those pesky requirements placed on insurance companies? They've found they are so popular that many companies plan to keep the benefits if the law is overturned...

neup99 wrote:Obamacare does have good ideas within it, however nationalized healthcare is a bad idea. In the short term, yes some people will benefit. However, the VA system and Medicare are good examples of why the nationalized system is going to negatively implact the entire healthcare system. Decreased reimbursement rates will decline significantly and those who live in towns with small hospitals may well be the first to see cuts or closing of critical access hospitals.

The Veterans Administration has a good system which is improving even more. I have been going to them for physicals, eye exams, etc. for many years. This winter I needed an operation and received it in a local hospital and the VA paid for most of it. Likewise most people want Medicare and are happy to have it rather than the alternative which for many would be nothing. Also even under the so-called nationalized systems, individuals may buy their own insurance if they wish.

Kerry Tobin wrote:Apparently some people still have no idea what is in the new Health Care Law. They didn't nationalize anything. One of it's biggest provisions is that people are finally REQUIRED to buy health insurance. Everyone uses health care sooner or later, I have no problem with requiring that people be able to pay for it.

Thanks for the misinformation Mr. Smarty Pants. It DOES NOT require people to buy health insurance. What it does is impose a penalty (now being called a tax) on people who choose not to buy it.

How about smokers? Those who don't quit smoking will put an increased burden on the health care system and will therefore be responsible for increasing others insurance rates. Should the government impose a penalty....ahem a tax......on them? It's the exact same reason a tax was imposed on them for choosing not to buy health insurance.

How about drinkers? chewers? People who don't eat 3 servings of vegetables a day? Do they need to be taxed for their poor choices too?

We've just slid down a very slippery slope. We no longer decide what's best for us individually....... The government has taken that over....

River Rat wrote:How about smokers? Those who don't quit smoking will put an increased burden on the health care system and will therefore be responsible for increasing others insurance rates. Should the government impose a penalty....ahem a tax......on them? It's the exact same reason a tax was imposed on them for choosing not to buy health insurance.

You mean the Cigarette Tax? Too Late!

How about drinkers?

Oh, you mean the Alcohol Tax? Yep, that exists too!

And you're right. The government doesn't require you get insurance. Oh wait, it does, or you get fined! Hmm, government doesn't require you stop at stop signs then either? Or pay your taxes? Who knew we could get away with so much...

The Cigarette tax is a tax paid by those who choose to pay it. It isn't mandatory that a person pays this tax. They can quit smoking a never pay a cent in taxes. Furthermore, the act of smoking is not taxed. The choice to smoke is not taxed. A person can grow and roll their own and not give the government a dime. There is personal choice here on many levels.

Obamacare created a tax that is imposed upon people who don't comply with what the government dictates. You are required to comply or be taxed. There's no "opt-out." There's no personal choice. You’re required to pay, one way or another, for simply being alive. Pay to breathe.

This is unprecedented in American history. That's why it's a big deal, that's why it went to the supreme court and that's why the decision they made is so important.

The stop sign violation analogy is so far off-base it’s not worth mentioning.

The Cigarette tax is a tax paid by those who choose to pay it. It isn't mandatory that a person pays this tax. They can quit smoking a never pay a cent in taxes.

Thanks for making my point. No one can "choose" to quit health care. Sooner or later, everyone needs care in one way or another.

I'll support your plan when doctors and hospitals can "choose" to not provide any coverage to those that don't pay and we cut the federal budget by over 20% by telling everyone on Medicare they can "choose" to pay for their own insurance...

And one more point. YOU asked if a smoking tax was next. I simply pointed out one already exists. The government would have a hard time telling you smoke, but can tell you buy cigarettes so they tax that. Again, everyone uses health care, and therefor it is perfectly legit to expect people to be able to pay for the services they use.

And for the stop sign comment. You ripped into me for saying the law "required" people to buy insurance. I'm simply pointing out the law requires you to do something in the same way street laws do. You either do it, or you pay the fine (tax).

You are "required" to do both, and if you don't, you're going to pay the penalty (well, assuming you get caught).

"How this will work for primary care is a little murkier. The general consensus seems to be that they will try to reimburse based on a similar set of nationally defined "quality measures" like they are using for hospital accreditation, Medicare center status, etc. For example, is Dr. Smith keeping his patient's HbA1C below 7.0%? (An indication of good long-term diabetes control). Is he keeping his patient's LDL less than 100? So on and so forth.

This all seems like a great idea on the surface, but without putting my own opinions into this, I offer the following scenarios for your consideration:

1.Dr. Smith and Dr. Johnson are both primary care physicians. They both have 10 identical patients with diabetes, for whom each physician prescribes the exact same, evidence-based, standardized diabetes protocol. 4 of Dr. Smith's patients are non-compliant with their insulin regimens, despite optimal counseling and the best efforts of Dr. Smith, thus their HbA1C values will be above the cutoff that qualifies them for a "good outcome." In the end, medication compliance is a patient choice which cannot be controlled by the physician and although Dr. Smith did everything right from a medical standpoint, those patients will be red-flagged and reimbursement decreased.

2.Dr. Unlucky is a cardiologist, and Bill is a patient of his with Congestive Heart Failure. Bill is receiving the evidence-based optimal medical management for his CHF (Carvedilol, ACE inhibitor, etc). Bill has been counseled extensively on the importance of a low sodium diet and careful fluid intake because of his CHF. Bill is a Cleveland Browns fan and they make it to the Superbowl for the first time since god only knows. Bill has a Superbowl party with his buddies and eats a ton of potato chips and drinks a few beers and ends up in the hospital with a CHF exacerbation. Dr. Unlucky is now dinged for a hospitalization for CHF exacerbation for a patient under his care, which will be reported and affect his pay.

It's situations like this that are worrying physicians. I urge you to remember these are just example scenarios, to give you, the reader, pause to consider what could be a greater problem.

What criteria will comprise these quality of care outcomes remains to be seen, so no one knows yet exactly how it will look, but believe me when I say that it's not the mandate that's the game-changer, it's what I've discussed above. This will fundamentally alter the face of the medical field, whether it's for better or for worse remains to be seen. Hopefully this was helpful."

Medicare reimbursments are already low. With these changes, in places were the payor mix is significantly higher in Medicare or government provided health insurances, the facility and the provider will see decreased reimbursments. This will do nothing to help keep critical access hospitals around.

"There are two parties in politics: Republicans and Democrats. Republicans have bad ideas, Democrats have no ideas." - Lewis Black

Kerry Tobin wrote:And for the stop sign comment. You ripped into me for saying the law "required" people to buy insurance. I'm simply pointing out the law requires you to do something in the same way street laws do. You either do it, or you pay the fine (tax).

You are "required" to do both, and if you don't, you're going to pay the penalty (well, assuming you get caught).

If you run a stop sign you pay a fine for violating the law.

Under Obamacare you are mandated to purchase a product or pay a tax in order to comply with the law. The tax for noncompliance is not a penalty, nor fine. In fact the Supreme Court determined that if it were the law would be unconstitutional.

I don't see any similarities between the two, and neither did the Supreme Court.

What we have now is the ability of the government to control a person’s lawful actions by the use of its broad ranging taxation power. We gave up a part of our freedom yesterday.

When former Governor Tommy Thompson promoted mandated health insurance he used the analogy of Car Insurance. One could use Flood Insurance. If you build in a Flood Plain it is mandated so to minimize the beating to the taxpayer. We all use health care at some point. The Republicans don't have a plan and they seem angry that someone else did.

The Fed already controls what they pay for Medicare so they aren't taking over anything. They are changing how they determine payment.

I find it interesting that the same group of people that demands teachers be paid based on results would be so offended that doctors face the same expectation... In both cases there are definitely situations where the teacher/doctor has no control over the situation (they are dependent on the actions of others).

Finally, a word to describe Obama, his administration and his voters. It should be included in the dictionary.

Ineptocracy (in-ep-toc'-ra-cy) - a system of government where the least capable to lead are elected by the least capable of producing, and where the members of society least likely to sustain themselves or succeed are rewarded with goods and services paid for by the confiscated wealth of a diminishing number of producers.

The National Institutes of Health has just released the results of a $200 million research study completed under a grant to Johns Hopkins.The new study has found that women who carry a little extra weight live longer than the men who mention it.

The Fed already controls what they pay for Medicare so they aren't taking over anything. They are changing how they determine payment.

I find it interesting that the same group of people that demands teachers be paid based on results would be so offended that doctors face the same expectation... In both cases there are definitely situations whee the teacher/doctor has no control over the situation (they are dependent on the actions of others).

That's a fair point and If the government would back something like Rhee's proposals, I would say that Medicare payments are fair game because the precedent had been set. However, they have not.

"There are two parties in politics: Republicans and Democrats. Republicans have bad ideas, Democrats have no ideas." - Lewis Black

Let's bring this discussion back to how the new ruling changes things in Wisconsin...

I have a real problem with Walker saying that he's not going to be a leader and start working on setting up Wisconsin's health care market now that the constitutionality of the law has been settled. Instead, he's going to wait and see if the Republicans can win the House, Senate, and White House in November and repeal the law. That seems highly unlikely. So, since Wisconsin will not have it's own plan in place (also, Walker turned down $37 million from the Feds to set up a marketplace) by the deadline of January 2012, the federal government is going to step in and set up Wisconsin's marketplace for us. Nice leadership Governor. He actually has a legitimate shot to let his actions speak louder than his words and create an efficient Wisconsin-style solution for Wisconsinites, and instead is going to pout about the Supreme Court's ruling and let the Feds do it for us.

"We can't expect the American People to jump from Capitalism to Communism, but we can assist their elected leaders in giving them small doses of Socialism, until they awaken one day to find that they have Communism."

Guess what, we are well on the way and it is our elected leaders that are giving it to us in small doses and taking away our freedoms a little at a time ! ! !

He was right when he said that "Your children will grow up under Communism" !

And we are letting it happen !

The National Institutes of Health has just released the results of a $200 million research study completed under a grant to Johns Hopkins.The new study has found that women who carry a little extra weight live longer than the men who mention it.

Regardless who wrote it or said it, it sure seems to hit the nail on the head !

And I remember when Khrushchev said this ! "Your children will grow up under Communism"

Call it Communism, Socialism or what ever, it amounts to the same bad idea. !

The National Institutes of Health has just released the results of a $200 million research study completed under a grant to Johns Hopkins.The new study has found that women who carry a little extra weight live longer than the men who mention it.

Then Mitt Romney is a Communist and a Socialist because he's the originator of the individual mandate! And all the founding fathers are Communists because they wrote a constitution which allowed "ObamaCare" to be ruled constitutional by a conservative majority supreme court! The world is ending because ObamaCare is making us Communists.... noooooooo!!!!!!!!!(hint: melodramatic sarcasm)

Making people who can afford to buy health insurance buy it so that the rest of us don't have to pay for their visits to the ER through higher premiums is not a bad idea. It's common sense. And it makes people take responsibility for themselves.

Last edited by XYZ1 on Wed Jul 04, 2012 7:53 pm, edited 1 time in total.